| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,585 |
3,478 |
$119K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,203 |
729 |
$99K |
| D1120 |
Prophylaxis - child |
3,201 |
3,088 |
$87K |
| D1206 |
Topical application of fluoride varnish |
2,616 |
2,570 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
642 |
411 |
$43K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
191 |
88 |
$36K |
| D1351 |
Sealant - per tooth |
1,189 |
372 |
$33K |
| D1110 |
Prophylaxis - adult |
684 |
666 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,116 |
936 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,147 |
1,063 |
$29K |
| D9999 |
Unspecified adjunctive procedure, by report |
756 |
730 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
459 |
427 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,157 |
1,118 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
184 |
129 |
$10K |
| D0330 |
Panoramic radiographic image |
351 |
334 |
$10K |
| D0160 |
|
204 |
190 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
829 |
789 |
$7K |
| D0274 |
Bitewings - four radiographic images |
435 |
426 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
165 |
149 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
31 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
917 |
520 |
$2K |
| D0602 |
|
195 |
190 |
$0.00 |
| D0603 |
|
719 |
704 |
$0.00 |
| D0601 |
|
92 |
89 |
$0.00 |